Provider Demographics
NPI:1821202391
Name:RAFI, SHABNAM (MA)
Entity Type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:RAFI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 GUINEVERE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2809
Mailing Address - Country:US
Mailing Address - Phone:949-654-8347
Mailing Address - Fax:
Practice Address - Street 1:3188 AIRWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4652
Practice Address - Country:US
Practice Address - Phone:714-689-1380
Practice Address - Fax:714-689-1381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health